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Alliance Physical Health Clinical Guidelines

The physical health guidelines on this page represent the current standard of care for screening and/or management of specific diseases for which there are special considerations that apply to the complex health and social conditions of our members.

Alliance Health strongly supports the use of evidence-based medicine and decision-making. Physical Health (PH) Clinical Practice Guidelines can be used as a point of reference when making decisions regarding the care of a member. These guidelines represent the current standard of care for screening and/or management of specific diseases for which there are special considerations that apply to the complex health and social conditions of our members. Alliance’s PH Clinical Practice Guidelines adhere to recommendations upheld by nationally recognized primary and specialty care health societies. When national guidelines are unavailable, work group comprised of Alliance staff, providers and consultants that are experts in their fields will develop clinical guidelines.

All the guidelines have been reviewed and approved for adoption by the Committee on Provider Quality to assist providers and consumers alike in the clinical decisions making process with the goal of improved patient management and enhanced quality of care. These guidelines reflect evidence-based treatment, but are not intended to be service definitions, or medical necessity criteria, though they may overlap.

Alliance will continue to review, revise and update its approved for adoption PH Clinical Practice Guidelines.

Alliance Physical Health Clinical Guidelines
TopicCodeDeveloper/Source (year)Guideline linkNotes and additional links
DiabetesE08-E13American Diabetes Association (2023)Diabetes CareMedical Management of Type 1 Diabetes
Introduction and MethodologyMedical Management of Type 2 Diabetes
Summary of Revisions
Standards of Care
American Association of Clinical Endocrinology (2023)AACE: Comprehensive Type 2 Diabetes Management Algorithm
Cardiovascular Disease99490, 99439, 99487, 99489, 99491American College of Cardiology/American Heart Association (2019)Guideline on the Primary Prevention of Cardiovascular Disease
National Library of Medicine (2023)Coronary Artery Disease Prevention - StatPearls - NCBI Bookshelf (nih.gov)
Hypertension99201-99205, 99212, 99213American Heart Association (2020)2020 International Society of Hypertension Global Hypertension Practice Guidelines (ahajournals.org)
American Heart Association (2020)2020 International Society of Hypertension Global Hypertension Practice Guidelines
COPD94010-94799
J44
The Global Initiative for Chronic Obstructive Lung Disease (2023)Global Strategy for the Diagnosis, Management, and Prevention of Chronic Pulmonary Disease (2023 Report)Pocket Guide to COPD Diagnosis, Management, and Prevention: A guide for Health Care Professionals
CKD585.1-585.6, 585.9National Kidney Foundation (2020)National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI)KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation
KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors
National Library of Medicine (2021)Chronic kidney Disease: Assessment and Management
American Academy of Family Physicians (AAFP) (2017)Chronic Kidney Disease: Detection and Evaluation
AsthmaJ44, J45National Heart, Lung and Blood Institute (2020)2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group
Global Initiative For Asthma (2023)Global Strategy for Asthma Management and Prevention: Pocket Guide for Asthma Management and Prevention
Centers for Disease Control and Prevention (2023)Asthma: Management and Treatment
Tobacco UseZ72.0American College of Cardiology (2018)2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment
American College of Obstetricians and Gynecologists (ACOG) (2020, reaffirmed 2023)Tobacco and Nicotine Cessation During Pregnancy
United Preventive Services Task Force (USPSTF) (2021)Prevention and Cessation of Tobacco Use in Children and Adolescents: Primary Care Interventions (April 2020)Recommendation: Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org) 1/2021
Centers for Disease Control and Prevention (2023)Smoking Cessation—The Role of Healthcare Professionals and Health Systems (cdc.gov)
PneumoniaJ18.9Centers for Disease Control and Prevention (2022)Pneumonia Management and Prevention GuidelinesPneumonia Can Be Prevented - Immunizations Can Help
American Family Physicians (2020)Community Aquired Pneumonia: Updated Recommendations from the ATS and IDSA
UpToDate (2023)Overview of Community-Aquired Pneumonia
Infectious Disease Society of AmericaCommunity Aquired Pneumonia (CAP) Clinical PathwayCommunity-Aquired Pneumonia Clinical Pathway Overview Presentation
HIV/AIDSB20, Z21United States Preventive Services Task Force (USPSTF) (2019)Human Immunodeficiency Virus (HIV) Infection: Screening
Prevention of Human Immunodeficiency Virus (HIV) Infection: Preexposure Prophylaxis
American College of Obstetricians and Gynecologists (ACOG)(reaffirmed 2020)Routine Human Immunodeficiency Virus Screening
U.S. Department of Health and Human Services (2023)Clinical Info: Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV
Clinical Info: Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV
Centers for Disease Control (2022)About HIV/AIDS
Infectious Disease Society of America (2021)Clinical Practice Guideline for Persons with Human Immunodeficiency Virus: 2020 Update by HIVMA/IDSA
This page was last reviewed for accuracy on 04/25/2024